Pill-Disposal Program

An Illinois County Provides Model to Get a Pill-Disposal Program Up and Running Lake County knew that preventing prescription drugs from getting into a water supply or the wrong hands is important. And it got help from Walgreens in its prescription turn-in efforts. Once every month, police officers from departments across Lake County, Illinois, converge on the Solid Waste Agency of Lake County, or SWALCO. They carry with them containers stuffed to the brim with unused prescription drugs. “It’s literally huge garbage bags filled with pills,” says Michael Nerheim, the state’s attorney for the county, which is north of Chicago, south of the Wisconsin state line and is home to about 700,000 residents. Mixed in among the standard over-the-counter medications are scheduled opioids destined to be sorted out, dumped into a vat of gasoline—which renders them inert—and then destroyed in a closed-loop incinerator. The whole process is part of the Lake County Prescription Drug Disposal Program, a local measure to fight the substance abuse epidemic. Why Invest in Drug Disposal? “We’re trying to attack the drug issue from multiple angles,” says Eric Guenther, police chief for village of Mundelein, a local jurisdiction in Lake County that has participated in the drug disposal program for several years. Fighting drug abuse from the supply side makes sense. In one study, 62 percent of teens polled said they had started misusing prescription drugs in part because the pills were easy to get from their parent’s medicine cabinets. As a result, take-back events have long been a part of the Drug Enforcement Administration's national strategy–this year's National Prescription Drug Take-back Day falls on April 30. According to Bill Gentes, a former mayor from the village of Round Lake who oversees the drug disposal program as the project coordinator for the local Drug Free Communities Program, Lake County destroys about 300 tablets of scheduled substances for every 100 pounds of pills collected. That may not sound like a big deal. But give that data some context and the potential impact becomes more impressive. In 2015, the program took in 30,000 individual doses of scheduled medications–which include powerful opioid painkillers like codeine, fentanyl and oxycodone. Accounting for the estimated $25-per-tablet street value of these medications, Gentes concluded that in one year, the program destroyed about $750,000 worth of controlled substances that might have ended up in the wrong hands, or, for that matter, in the county’s drinking water supply. The environmental argument on behalf of sensible pill disposal cannot be overstated. In a 2009 study carried out by the University of Illinois, residents of Cook County—Lake County’s larger neighbor to the south and home to Chicago—were polled on their personal drug disposal habits. Of those that responded, 59 percent said they throw away unused or expired medications in household garbage and 31.3 percent of respondents said they flush these meds down the sink or toilet. Either do-it-yourself disposal method means that these drugs have a chance at ending up in the water supply. Researchers examining the problem nationally have found traces of pharmaceutical drugs in the drinking water of up to 40 million Americans. In terms of the project’s impact on substance abuse, Lake County officials involved with the program—including Gentes and Nerheim—were quick to emphasize that no causal link has been established between the success of the project and changes in the county’s rate of fatal overdoses. Yet, it must be said that the county has seen a steep decrease in the number of deaths involving scheduled prescription medications as the program has picked up steam. In 2011, 41 Lake County residents died from prescription pill overdoses. Four years later, in 2015, that number has dropped to 18. Local government leaders aren’t the only ones taking notice of the importance of pill disposal. In February, the national pharmacy chain, Walgreens—which is headquartered in Deerfield, Illinois—announced that it would be rolling out medication disposal kiosks in more than 500 stores in 39 states and Washington, D.C. While Walgreens would like to have kiosks in all 50 states, regulations that prevent drug take-back at retail locations have kept the company from reaching that goal. Casey Cesnovar, the senior director of state and local government relations for Walgreens made it clear that the company will be working closely with state legislatures to address those regulations. The Walgreens decision, and the Lake County project are somewhat linked. Members of the coalition that runs the Lake County pill disposal program have been in conversation with Walgreens’ policy office, and a member of that office sits on the Lake County opioid task force. State’s Attorney Michael Nerheim was present at Walgreens’ announcement of its drug take-back project. Too Successful for Its Own Good Lake County’s Prescription Drug Disposal Program began in 2007 when the county installed its first collection boxes—refurbished mailboxes—that are provided by a locally-based non-profit, Save A Star Drug Awareness Foundation. The boxes went into the lobbies of a handful of county police departments. At this time, federal regulations made prescription drug diversion options—other than law enforcement—prohibitively difficult, and places like hospitals and long-term care facilities were barred from accepting unused prescription medications. Up until 2014, even pharmacies weren’t allowed to collect these drugs, which explains why Walgreens is just now joining in with its initiative. By 2012, Lake County’s program continued to grow and had been instituted in nine local police departments. At this point, the initiative was running up against several logistical roadblocks. For one, the only way to destroy the drugs police departments were collecting was to drive them 4.5 hours away to a DEA-sanctioned facility in Indianapolis. And, this option was only available twice a year as part of nationwide DEA take-back events. Aside from the lengthy drive—which on its own made recruiting additional police departments to the program difficult—the overwhelming success of the program in terms of pounds of medications collected, had become a barrier to scaling up. For instance, the community of Zion, with a population of about 20,000 residents, was collecting upwards of 100 pounds of medication per month. According to Gentes, 100 pounds of drugs take up about two phone booths worth of space. Put simply, smaller police departments in the program were running out of storage space in their evidence lockers. Overcoming Obstacles So Gentes, working closely with a coalition of partners—including the Lake County Underage Drinking and Drug Prevention Task Force, the Lake County Opioid Initiative, the county State’s Attorney’s Office, the Sheriff’s Office and municipal police departments—set out to find a new way for the program to dispose of pills more often and closer to home. The first step was to identify a site that would be able to handle the disposal of these medications. That’s where the Solid Waste Agency of Lake County came in. SWALCO is one of six facilities in Illinois that’s permitted to handle prescription drugs. If the coalition could secure funding, they could make prescription pill disposal a monthly occurrence, right in Lake County—no four or five hour drive to Indianapolis was needed. The coalition took their plan all the way to the Illinois State Senate, and proposed a bill that would make Lake County prescription drug disposal a state pilot program. That bill, S.B. 2928, was passed unanimously in both the House and the Senate in early 2014. By the end of 2014, the pilot project status was removed, and the pill disposal program was recognized as an official state program. The coalition was also able to secure funding through the Illinois Environmental Protection Agency, which allows for continued monthly destruction days at SWALCO. In January, 2015, the county held its first monthly take-back day, at SWALCO, funded by the IEPA, with a total of 18 participating police departments. By the end of that year, Gentes and others in the coalition had helped recruit 10 more departments, bringing the total of participating municipalities to 28 out of the 33 in the county that are eligible for the program. In 2015 alone, the program managed to collect 12,000 pounds of pills. To put in perspective how successful this program has been, Lake County makes up just 5 percent of the total population of the state of Illinois, yet the county was responsible for collecting close to 25 percent of the unused prescription medication in the state. Lessons Learned The primary factor to which Gentes attributes the success of Lake County’s drug disposal program is that he made it a goal to, in his own words, “clear away the undergrowth.” From the very beginning, the program needed buy-in from police departments all over the county to succeed. Beyond the effort to bring the disposal option closer to home, and to increase the frequency with which departments could empty the boxes, Gentes went out of his way to streamline the experience for departments. Gentes created a set of model general orders through the sheriff’s office, so that police departments that are new to the program could hit the ground running with the initiative from day one. By working with the county Sheriff’s office, Gentes also ensured that every monthly collection is as simple as possible for each individual municipal police department—which makes the process, in the words of Chief Guenther, “really easy when you drill down into it.” Each month, the Sheriff’s Office staffs the destruction site, so all the individual departments have to do is send a few officers with the contents of their collection box to SWALCO, and then go back to work. Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference. Gentes says that “circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. A Wicked Problem Chief Guenther would be the first to admit that policing the substance abuse epidemic is complicated work. “You’re putting an officer out there to do a job, and too often he’s also required to be a social worker, a marriage counselor and an addiction counselor.” Therefore, when opportunities like pill disposal programs present themselves that allow law enforcement to participate in a project that is relatively low-cost, a low burden in terms of manpower, but with the potential for a high impact, it’s something that every county should take advantage of.